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<html xmlns="http://www.w3.org/1999/xhtml">
<head>
	<title>Mobile Sugare Measurement</title>
	<meta http-equiv="Content-Type" content="text/html; charset=utf-8" />
	<link rel="stylesheet" type="text/css" href="master.css" />
	<script type="text/javascript" src ="birthdate.js">
	<script type="text/javascript" src="http://gettopup.com/releases/latest/top_up-min.js"></script>
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</head

<body>
<div id="pagewidth" class="profile">
<a id="logo-zone" href="index.html">_____</a>
	<div id="top">
		<h2>Mobile Sugar Measurement</h2>
	</div>

	<div id="header">
		<h3>Profile Settings</h3>
	</div>

	<div id = "content">
		<form name="myform" method="post">
			<table id = "profile_settings" width="100%">
			<tr>
				<td style="width: 180px">Name: </td>
				<td><input type="textbox" name="name" value="name" style="WIDTH:100px" /></td>
			</tr>
			<tr>
				<td>Address</td>
				<td><input type = "textbox" name = "address" value = "address" style= "WIDTH:100px" /></td>
			</tr>
			<tr>
				<td>Birth date: (yyyy/mm/dd)</td>
				<td><input type = "textbox" name = "year" maxLength=4 style="WIDTH: 40px" value = "1992"/>
					/ <input type = "textbox" name = "month" maxLength=2 style="WIDTH: 20px "value = "01"/>
					/ <input type = "textbox" name = "day" maxLength=2 style="WIDTH: 20px" value = "10"/>
				</td>
			</tr>
			<tr>
				<td>Sex:</td>
				<td>
					<select "multiple">
					<option value="Female">Female</option>
					<option value="Male">Male</option>
					</select>
				</td>
			</tr>
			<tr>
				<td>Height: </td>
				<td><input type = "textbox" name = "height" maxLength =3 style = "WIDTH: 40px" value = "170"/> cm </td>
			</tr>
			<tr>
				<td>Weight: </td>
				<td><input type = "textbox" name = "weight" maxLength =3 style = "WIDTH: 40px" value = "60"/> kg </td>
			</tr>
			<tr>
				<td>Diabetes type</td>
				<td>
					<select "multiple">
					<option value = "Type 1">Type 1</option>
					<option value = "Type 2">Type 2</option>
				</td>
			</tr>
			<tr>
				<td>Phone number: </td>
				<td><input type = "textbox" name = "phone" style = "WIDTH:100px" maxLength = 10 value = "012-3456789"/></td>
			</tr>
			<tr>
				<td>E-mail: </td>
				<td><input type = "textbox" name = "mail" style = "WIDTH:100px" value = "me@somebody.com"/></td>
			</tr>
			<tr>
				<td>Doctor name: </td>
				<td><input type = "textbox" name = "doc" style = "WIDTH:100px" value = "Dr. Schipper"/></td>
			</tr>
			<tr>
				<td>Emergency no: </td>
				<td><input type = "textbox" name = "em-nr" style = "WIDTH:100px" maxLength = 10 value = "112"/></td>
			</tr>
			<tr>
				<td colspan="2" style="text-align: center;">
				<a href="index.html"><img SRC="images/submit.png" 
					   WIDTH="120"  HEIGHT="30" 
					   BORDER="0" ></a></td>
			   </tr>
		</table>
	</form>
</div>

</div>

</body>
</html>

